Healthcare Provider Details

I. General information

NPI: 1053631689
Provider Name (Legal Business Name): FOUNTAIN HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2010
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3554 HULMEVILLE RD STE 106
BENSALEM PA
19020-4366
US

IV. Provider business mailing address

3554 HULMEVILLE RD STE 106
BENSALEM PA
19020-4366
US

V. Phone/Fax

Practice location:
  • Phone: 215-639-3185
  • Fax: 215-639-3184
Mailing address:
  • Phone: 215-639-3185
  • Fax: 215-639-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1024539660001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. EMMANUEL UGWUOKE
Title or Position: PRESIDENT
Credential: M.D
Phone: 267-266-6820